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The story focuses on a conversation between an American man and a girl at a Spanish train station while waiting for a train to Madrid. The girl compares the nearby hills to white elephants. The pair obliquely discuss an "operation" which the man wants the woman to have, which is implied to be an abortion. The scene ends with the arrival of the train.[2]

The girl's reference to white elephants could be in regards to the baby. The American could see the baby as a white elephant and does not want to raise it because of the cost, while the girl could see the child as an extraordinary addition to her mundane life of drinking and mindless traveling.[3] "Hills Like White Elephants" shows Hemingway's use of iceberg theory or theory of omission: a message is presented through a story's subtext; for instance, in the story the word "abortion" is never mentioned, although the male character seems to be attempting to convince his girlfriend to have an abortion.[4] The symbolism of the hills and the big white elephant can be thought of as the images of a pregnant woman's swollen breasts and abdomen, and the prenatal dream of the mother of the future Buddha in which a white elephant appears to her (in this case, as a symbol of prestigious leadership).[5]

Apart from the hills, other parts of the setting provide symbolism which expresses the tension and conflict surrounding the couple. The train tracks form a dividing line between the barren expanse of land stretching toward the hills on one side and the green, fertile farmland on the other, symbolizing the choice faced by each of the main characters and their differing interpretations of the dilemma of pregnancy. The girl focuses on the landscape during the conversation, rarely making eye contact with the American.[6]

"They look like white elephants," she said.
"I've never seen one," the man drank his beer.
"No, you wouldn't have."
"I might have," the man said. "Just because you say I wouldn't have doesn't prove anything."
The girl looked at the bead curtain. "They've painted something on it," she said. "What does it say?"
"Anis del Toro. It's a drink."
"Could we try it?"

The reader must interpret their dialogue and body language to infer their backgrounds and their attitudes with respect to the situation at hand, and their attitudes toward one another. From the outset of the story, the contentious nature of the couple's conversation indicates resentment and unease. Some critics have written that the dialogue is a distillation of the contrasts between stereotypical male and female relationship roles: in the excerpt above, for instance, the girl draws the comparison with white elephants, but the hyper-rational male immediately denies it, dissolving the bit of poetry into objective realism with "I've never seen one." By saying, "No, you wouldn't have" she implies he hadn't had a child before, or hadn't allowed birth in the past. She also asks his permission to order a drink. Throughout the story, the girl is distant; the American is rational.[7] While the American attempts to frame the fetus as the source of the couple's discontent with life and one another, the tone and pattern of dialogue indicate that there may be deeper problems with the relationship than the purely circumstantial. This ambiguity leaves a good deal of room for interpretation; while most critics have espoused relatively straightforward interpretations of the dialogue (with the girl as the dynamic character, traveling reluctantly from rejection to acceptance of the idea of an abortion), a few have argued for alternate scenarios based upon the same dialogue.[8]